Credit Request

Please complete all sections. Click the Submit button to continue.

Universal Intermodal Credit Request
Terminal*
Line Of Credit Requested*
Is This For A Broker*
Email*
Load Information
Load Date*
Load Revenue*
Number Of Loads*
Per*
Commodity*
From Company
From Location
To Company
To Location
Credit Check Requested For
Business Name*
Phone*
Fax*
Broker MC #*
DUNS #*
Address Line 1*
Address Line 2
City*
State/Province*
Zip*
Contact*
Federal Tax ID Number*
Years In Business*
Has the firm or any of its principals ever filed bankruptcy?*
EDI Capable?*
EFT Capable?*
Auto Pay?*
Required Customer Documentation For Freight Payment*
- Bill Of Lading
- Load / Reference Number
- Copy Of Permits
- Copy Of Scale Tickets
Comments
References
References available if requested?*
Carrier References
Name
Address
Phone
Name
Address
Phone
Name
Address
Phone
Bank References
Name
Address
Phone
Account Number
Contact
CAPTCHA

Universal Intermodal